Natural History of Syphilis and Levels of Prevention

From the viewpoint of prevention, syphilis, like other disease processes, has its origin before man himself is affected.Therefore, application of pre- ventive measures need not await man's actual exposure to the causative agent.There are possibili- ties of intercepting the various related " causes " which lead to exposure, as well as of interrupting the process after it begins in man.The complete process, at least for preventive purposes, may be termed the " natural history of the disease ", which begins with the very first forces that initiate it in the environment or elsewhere, and continues through the resulting changes that take place-until equilibrium is reached, or defect, disability, or death ensues.There is a " period of pre-pathogenesis " before man's contact with the disease agent, and one of " pathogenesis " after man harbours the Treponema pallidum.Preventive measures may be applied throughout these two periods.The disease may be attacked from at least five preventive points during these two periods:(a) health promotion; (b) specific protection; (c) early recognition and prompt treatment;(d) disability limitation (e) rehabilitation.